COVER STORY Euthanasia: shutting up by shouting down

by Margaret Somerville

News Weekly, April 8, 2017

On March 26 the Australian Family Association hosted a talk on assisted suicide/euthanasia by Professor Margaret Somerville. Professor Somerville is Samuel Gale professor of law emerita in the faculty of medicine and founding director emerita of the Centre for Medicine, Law and Ethics at McGill University in Montreal, Canada, where she taught for more than 30 years. Last year she returned to Australia to take up a position as professor of bioethics in the School of Medicine at Notre Dame University in Sydney.

Professor Margaret Somerville

Very recently, I was a participant in a Q&A panel on Voluntary Assisted Dying at the Australian Medical Association Victoria Congress 2017. I was pleased to have been invited and hopeful that there would be a balanced discussion. But I was also concerned that that might not be realised in practice, given the membership of the panel.

The panel participants included well-known advocate of the legalisation of doctor-assisted suicide Andrew Denton and Greens leader Senator Richard Di Natale, who also supports its legalisation in certain circumstances.

The chair was Dr Sally Cockburn, another supporter of the legalisation of doctor-assisted suicide. I oppose legalising both doctor-assisted suicide and euthanasia.

Unfortunately, my concerns were well placed.

First, my participation in the discussion was limited in several ways. The Dr Cockburn in the chair told me that the question of whether legalising doctor-assisted suicide or euthanasia was a good or bad idea, ethical or unethical, was not open for discussion.

She explained that the only topics to be discussed were the conditions that should apply for access to assisted suicide and how it should be regulated. In short, the panel was based on an assumption that legalising assisted suicide was inevitable in Victoria, even though legislation has not yet been tabled in the Victorian Parliament, let alone debated or enacted. This assumption is a pro-assisted suicide/euthanasia strategy as it leads people to believe there is no point in discussing views opposing legalisation.

Legislative bodies only regulate conduct that they and the community consider to be ethical under certain conditions, and they regulate to set out those conditions. We prohibit conduct we believe to be inherently unethical, as those who oppose euthanasia believe it to be. Consequently, discussing regulation affirms the position that assisted suicide and euthanasia are ethically acceptable.

More than once the chair told me that I had been invited as a lawyer and not as an ethicist, despite the fact that the latter has been my main professional role for 40 years. Given this proviso, it was not unexpected that the questions addressed to me from the chair were purely legal ones; for instance, I was asked to define mental capacity and dignity.

This gave me speaking time and an appearance of fair time allocation among panellists, without opening up an opportunity for me to present the anti-assisted suicide/euthanasia arguments I wanted to propose.

A theme developed by the panellists who agreed with legalising assisted suicide was that being absolute on the issue of its legalisation is “not helpful” and that the voices in the debate should be those of reasonable people who were not absolutists. This, in fact, amounts to another pro-euthanasia strategy, because if one is not against the legalisation of assisted suicide or euthanasia, one is necessarily for it in some form. While some people might be uncertain where they stand, there is no entirely neutral position.

At the beginning of the event, the chair told the audience that they should text questions to her and that she would collate and present them; those who did not have an iPhone were told they should raise their hand and ask the question in person. She added that if the questioner spoke for too long or was presenting commentary or policy, rather than a question, the audience could shout “No, no, no!” and she would cut off the person.

It seems reasonable to assume this invitation was offered only in relation to an audience member asking a question. But when I prefaced an intervention by saying that I wanted to describe a case of euthanasia that showed its risks and harms, the chair interjected and said, “No stories please”. A substantial percentage of the audience immediately joined in to shut me down, shouting, “No, no, no, no stories”.

In 40 years of giving speeches on average around 25 to 30 times a year, I have never encountered such an incident. Moreover, bear in mind that I was an invited guest speaker sought out by the AMA to be a Q&A panellist at the congress and the audience were all, or almost all, medical doctors.

This behaviour does not fulfil the requirements of respectful discussion. Indeed, it is designed to stifle, rather than facilitate, debate on an important social and medical issue, and can be characterised as bullying.

A positive aspect of the panel was that Andrew Denton – one of the very few people present who was not a medical doctor – did behave respectfully with regard to my anti-euthanasia arguments and towards me. And a positive and important message, delivered by the gerontologist and psychiatrist on the panel, was that we shouldn’t even be talking of legalising euthanasia until we have fully adequate palliative care available to all who need and want it, which is far from the case at present in Australia.

In summary, my experience can be characterised as involving silencing and intimidation and a failure to respect freedom of speech.

Many people with traditional or conservative values, especially young people, when they encounter such experiences respond by self-censoring. They tell me, privately, that they share some of the values I present, but would never say so publicly for fear of being ridiculed or shamed or, even, not being employed or promoted.

The same is true of many conservative politicians who fear losing votes.

We should also always keep in mind that whether we are for or against legalising doctor-assisted suicide and euthanasia, we have a common goal of relieving suffering. Where we disagree is the limits on the means we may use to do this. I believe we should kill the pain and suffering, not the person with the pain and suffering.

The vignette that I describe has wide ethical implications in relation to the quality and character of public debate, which is essential to a healthy democracy and maintaining a society in which reasonable people would want to live.

Perhaps one of the most disturbing aspects of this event is that it was an Australian Medical Association Victoria congress and, as I’ve noted already, almost everyone present, whether as speakers or in the audience, was a medical doctor.

In secular, democratic, pluralist, multicultural societies like Australia, medicine is a major values-creating and values-carrying institution for society as a whole, because it is one of the few institutions to which we all personally relate. That means it must be open to taking into account the full range of people’s commitments and values systems.

We need to ask whether, in the organisation and conduct of this Q&A panel, the AMA Victoria lived up to its responsibilities in this regard.

Evicting religious voices

The Australian reports: “Denton tells church to get out of euthanasia debate” (August 11, 2016); and the ABC website that “Andrew Denton has lashed out at a “subterranean Catholic force” of politicians and businessmen who he claims continue to thwart attempts to allow legally assisted voluntary euthanasia in Australia.

This is the “label as religious – in particular, Roman Catholic – and dismiss” strategy favoured by many pro-euthanasia advocates. It is applied to both clergy and members of the public with religious beliefs.

The strategy is founded on the argument that religious beliefs are unacceptable as an informing principle for values decisions other than purely personal ones, especially those decisions relevant to public and social policy, and, consequently, religious people’s voices should be excluded from the public square.

It’s a strategy used to avoid discussing the arguments or views of people with religious beliefs, whether or not their arguments and views are religiously based. They and their arguments are dismissed simply on the basis of their having a religious affiliation. The assumption underlying this strategy and purportedly justifying it is that people who have religious beliefs are puppets of their church – unthinking, uncritical automatons.

People who use this strategy, like Andrew Denton, overlook that everyone has a belief system. For example, secularism and atheism are belief systems, yet their adherents are not automatically dismissed for being such and should not be, because in a democratic society everyone has a right to a voice in the public square. To silence people because they are religious is anti-democratic and discriminatory, just as silencing atheists and secularists would be.

If Mr Denton has good arguments against his Catholic opponents’ positions he should present them and show why these Catholics’ arguments should not prevail, instead of trying to suppress them. Indeed, his efforts to do the latter makes one wonder if he believes his arguments will fail if they are competently challenged.

The euthanasia debate involves ethical decision-making, therefore, not only reason, but also other human ways of knowing – such as “examined emotions” and intuition, especially moral intuition – play an important role. A wise axiom in applied ethics is that “we ignore our feelings at our ethical peril”. That is not to say we should act just on the basis of our emotional reactions, but that we must carefully examine these reactions and take them into account in ethical decision-making.

We must react with compassion and care for people who are suffering from horrible illnesses, but our reaction should be to kill the pain and suffering, not the person with the pain and suffering.

Humans have an innate reluctance to killing another human being and rightly recoil from doing so. Indeed, in the past, soldiers have been psychologically deprogrammed in order to be able to kill an enemy soldier at close quarters. So might we need to be more concerned about the ethics of doctors willing to inflict death, than the ethics of those who refuse to do so for reasons of conscience or religious belief?

A case in point has arisen in Canada where euthanasia has recently become legal. Pro-euthanasia advocates are trying to force doctors with conscientious or religious objections to euthanasia to participate in it. We should keep in mind that a doctor’s good conscience is a patient’s last protection.